Endocrine Abstracts

Objective: The Swiss Primary HyperParaThyroidism (PHPT) Cohort Study is an ongoing, prospective, non-interventional project collecting clinical, densitometric, biochemical and outcome data in patients with PHPT. The aims are to describe the profile of these patients particularly neurobehavioral and cognitive symptoms, changes in calcium and PTH over time and treatment modalities.

Methods: Patients newly diagnosed with PHPT and with high serum calcium levels were enrolled. Physicians recorded data on a web-based system (https://www.phpt-registry.ch). Follow-up data were recorded at least every 6 months according to NIH guidelines. If a parathyroidectomy (PTX) was decided, a final visit took place within 6 months after surgery. Changes in neuropsychological functioning are evaluated yearly and within 3 to 6 months after PTX.

Results: From June 2007 to September 2008, 99 patients (mean age 69.3±14.6 years; 73% female) have been included. Median preoperative calcium and PTH levels were 2.72 mmol/l (Inter-Quartile Range: 2.61–2.86 mmol/l, normal range: 2.20–2.60 mmol/l) and 13.8 pmol/l (IQR: 9.2–17.6 pmol/l, N: 1.1–6.8 pmol/l), respectively. Densitometric osteoporosis was documented in 27 cases (out of 66 measurements). Forty eight patients presented with a classic symptomatic form of PHPT (history of renal lithiasis, low-trauma fractures, or muscle weakness). Twelve asymptomatic patients were considered as candidates for surgery, having at least one of the 2002 NIH criteria. Of the 39 patients who were not candidates for surgery (with no NIH criteria), 10 had nonspecific symptoms and 29 were truly asymptomatic. Twelve patients were started on cinacalcet, including one post-operatively.

Conclusion: Our preliminary results show that although many patients undergoing parathyroidectomy have a paucisymptomatic profile of PHPT, the classic form remains frequent. Sixty patients were symptomatic or fulfilled at least one criterion of the NIH guidelines, and were referred for surgery. Among the medical options, cinacalcet was prescribed in 12% of patients.